早期足量蛋白质摄入对极低出生体重儿生长影响的临床研究

目的探讨早期足量蛋白质摄入对极低出生体重儿(very low brith weight infant,VLBWI)早期生长速率的影响。方法将出生体重1 000~1 500g并治愈出院的61例VLBWI随机分为研究组n=31,氨基酸2.0g/(kg·d)开始,1.0g/(kg·d)递增]和对照组n=30,氨基酸0.5~1.0g/(kg·d)开始,0.5g/(kg·d)递增],比较两组蛋白质、能量摄入情况及蛋白/能量比,血生化指标、体格增长及合并症等,并对两组蛋白质和能量摄入及蛋白/能量比与体格增长速率的关系进行相关分析。结果研究组体重下降幅度比对照组低(6.2%vs 9.5%),恢复至出生体重时间比对照组早(6dvs10d)(P均0.05);平均每周头围增长速率比对照组快(0.75±0.32)cm vs(0.45±0.25)cm)](P0.05);每日平均体重增长速率比对照组快(22.3±3.2)g/kg vs(15.1±2.3)g/kg(P0.05);平均每周身长增长速率差异无统计学意义(P0.05)。第3天、第7天总热卡及蛋白质摄入、蛋白/能量比与恢复出生体重后每日平均体重增长速率及平均每周头围增长速率呈正相关(均P0.05)。两组患儿平均血清总胆汁酸及尿素氮水平差异无统计学意义,但平均白蛋白水平研究组明显高于对照组(P0.05)。结论早期足量蛋白质摄入能够降低VLBWI出生早期的体重下降幅度,更早恢复至出生体重,加速住院期间的体重及头围增长速度。

Effect of early adequate protein intake on growth of very low birth weight infant.

Objective To investigate the effect of early adequate protein intake on early growth rate of very low birth weight infant (VLBWI). Methods A total of 61 cured cases of VLBWI with birth weight of 1 000~1 500 g were randomly divided into the study group n=31,amino acids 2.0 g/(kg·d) start,1.0 g/(kg·d) increments] and the control group n=30,amino acids 0.5~1.0 g/(kg·d) start,0.5 g/(kg·d) increments],protein,energy intake and protein / energy ratio ,blood biochemistry,physical growth and complications,etc of two groups were compared,and the relationship of protein intake,energy intake,protein / energy ratio and physical growth rate were analyzed. Results Study group's weight decreased lower than the control group's (6.2% vs 9.5%)(P<0.05),returned to birth weight earlier than the control group's (6 d vs 10 d)(P<0.05);The average weekly growth rate of head circumference ratio was faster than control group (0.75±0.32)cm vs (0.45±0.25)cm](P<0.05);The average daily weight increased faster than the control group (22.3±3.2)g/kg vs (15.1±2.3)g/kg](P<0.05);Average weekly rate of height growth had no difference between two groups (P>0.05).The first three days,the first seven days of total caloric and protein intake,protein/energy ratio,and average daily weight gain,average weekly rate of head circumference growth rate after recovery to birth weight were positively correlated (P<0.05).There was no significant difference of infant with mean serum total bile acid and urea nitrogen levels between the two groups,but the average albumin level of study group was significantly higher (P<0.05). Conclusion Early adequate protein intake can reduce the weight decrease of VLBWI in early birth period,earlier return to birth weight can accelerate weight gain and head circumference growth rate during hospitalization.